RT Journal
A1 Swartz MJ, Hughes MA, Frassica DA, et al
T1 ADjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum
JF Archives of Surgery
JO Archives of Surgery
YR 2007
FD March 1
VO 142
IS 3
SP 285
OP 288
DO 10.1001/archsurg.142.3.285
UL http://dx.doi.org/10.1001/archsurg.142.3.285
AB Hypothesis 
    Adjuvant chemoradiation improves local control and survival in patients with node-positive duodenal adenocarcinoma treated with pancreaticoduodenectomy.Design 
    A retrospective review of outcomes, with a planned comparison with historical controls.Setting 
    A single, high-volume academic referral center.Patients 
    All patients with periampullary carcinoma treated with pancreaticoduodenectomy and adjuvant chemoradiotherapy at The Johns Hopkins Hospital between 1994 and 2003. Fourteen cases of node-positive duodenal adenocarcinoma were identified. Median radiation dose was 5000 cGy (range, 4000-5760 cGy). Concurrent fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy.Results 
    The median follow-up was 12 months for patients who died and 42 months for those who lived. Death occurred in 7 of 14 patients (50%) during the follow-up period. Median survival for all patients was 41 months, and the 5-year survival rate was 44%. Of the 7 patients who experienced disease recurrence, 6 experienced distant metastasis as first recurrence. One of these 7 patients experienced both local recurrence and distant metastasis. Local control for all patients in the study was 93%, which compares favorably with local control reported in a series of patients treated with surgery alone (67%). Compared with historical controls treated with surgery alone, patients who received adjuvant chemoradiation therapy had an improved median survival (21 months vs 41 months, respectively). Overall 5-year survival, however, was not improved (44% vs 43%, respectively).Conclusion 
    Adjuvant chemoradiation therapy after pancreaticoduodenectomy for node-positive duodenal adenocarcinoma may improve local control and median survival but does not impact 5-year overall survival.